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The making of test tube babies

Experts warn against quacks

By Azoma Chikwe

In-vitro fertilization (IVF) is the most common and most effective type of assisted reproductive technology (ART) to help women become pregnant. The IVF procedure involves fertilising an egg outside the body, in a laboratory dish, and then implanting it in a woman’s uterus.

In a normal pregnancy, a sperm penetrates a woman’s egg and fertilises it inside her body after ovulation – when a mature egg has been released from the ovaries. The fertilised egg (now an embryo) then attaches itself to the wall of the uterus (womb) and begins developing into a baby. This is known as natural conception.

However, some women are unable to become pregnant through natural or unassisted conception and have to undergo fertility treatment to become pregnant. If less expensive fertility techniques do not work, some women may decide to opt for IVF. According to the American Society for Reproductive Medicine, about 1% of U.S. infants are conceived through IVF. To date, IVF has contributed to approximately 5 million births.

IVF has been used since the late ‘70’s. On 25 July, 1978, the first test-tube baby, Louise Brown, was born. Robert Edwards and Patrick Steptoe, who were both responsible for the birth, are considered to be the pioneers of IVF. In 2010, Robert Edwards was awarded the 2010 Nobel Prize in Physiology or Medicine “for the development of in-vitro fertilization”.

In July, 2013, an American couple had the first IVF baby to be born as a result of next generation DNA sequencing, a new way of screening embryos that improves IVF success rates and significantly reduces the cost of treatment. DNA sequencing technology helps doctors screen embryos created by IVF to identify those most likely to lead to successful pregnancies.

IVF procedure

IVF techniques may differ depending on the clinic, but usually involves the following steps: Step one involves suppressing the natural menstrual cycle. Women are given a drug (generally in the form of a daily injection) for about two weeks, which suppresses their natural menstrual cycle.

In step two, super ovulation is done. Fertility drugs containing the fertility hormone follicle stimulating hormone, FSH, are administered to the woman. FSH makes the ovaries produce more eggs than normal. Vaginal ultrasound scans can monitor the process in the ovaries.

Step three involves retrieving the eggs. The eggs are collected through a minor surgical procedure known as “follicular aspiration”. A very thin needle is inserted through the vagina and into an ovary. The needle – which is connected to a suction device – sucks the eggs out. This process is repeated for each ovary.

Researchers wrote in the journal Human Reproduction, that doctors should collect around 15 eggs from a female’s ovaries in one cycle if they want her to have the highest chance of giving birth to a child after ART.

Step four is insemination and fertilization .The eggs that have been collected are placed together with male sperm and kept in a environmentally controlled chamber. After a few hours, the sperm eventually enters the egg. However, sometimes the sperm is directly injected into the egg, this is known as an intracytoplasmic sperm injection (ICSI).  Researchers reported that frozen sperm retrieved through testicular biopsy is as effective as fresh sperm in achieving successful IVF pregnancy.

The fertilized egg divides and becomes an embryo. At this point, some centers offer pre-implantation genetic diagnosis (PGD) which can screen an embryo for genetic disorders, a somewhat controversial technique not always used. 

Either one or two of the best embryos are selected for transfer. The woman is then given progesterone or chorionic gonadotrophin (HCG) to help the lining of the womb receive the embryo.

Step five is embryo transfer. Sometimes, more than one embryo is placed in the womb. It is important that the doctor and the couple wishing to have a child discuss how many embryos should be transferred. Generally speaking, doctors should only transfer more than one embryo if there are no ideal embryos available.

The transfer is done via a a thin tube (catheter), which goes up the vagina and into the womb, successfully transferring the embryo. When the embryo sticks to the lining of the womb healthy embryo growth begins.

The success rates range from 40.1 per cent per embryo transfer leading to a live birth for patients under 30 years, to 8.5 per cent per embryo transfer leading to a live birth for patients over 40 years. It does not include any additional frozen embryo transfers that may have eventuated from that IVF treatment cycle.

Experts have warned couples planning in-vitro fertilisation session to beware of charlatans who parade themselves as fertility specialists. Being a gynaecologist does not certify a doctor a fertility specialist. Charlatans are extorting money from people in the guise of doing IVF  when actually what they do is inter-uterine insemination (IUI).

Warning against quacks

Dr. Abayomi Ajayi, Medical Director, Nordica Fertility Centre, explained the difference  between IUI and IVF, “ IUI and IVF are cousins but they are not interchangeable; they both belong to Assisted Reproductive Techniques but the most basic form in that family or the least developed is IUI which any doctor can do. You seriously don’t need any particular equipment to do that except to prepare sperm because we know that when the semen comes, there is sperm, there is seminal fluid. So, they are separated from each other,  the sperm is concentrated, and  introduced into the woman. For a woman to do IUI, the tubes must be open, the sperm count must be good.

“Looking at it in this environment, where the commonest problems are blocked tubes and bad sperm quality, it has very limited use, but some people will still benefit from it . However, patients must be sure of two things – the sperm parameters are good, and tubes are open. It is useless for anybody with blocked tubes to do IUI, if you do one million, you can’t get pregnant.

“People are mixing up the two and patients are not any wiser. For IVF to be done, you need to bring out the sperm, egg, make the two of them come together and have an embryo before transfering back into the patient. To do this, it starts with drugs which makes the woman produce eggs which are harvested, fertilised, before they are transferred back into the woman.; That is why it is called IVFET, IVF and Embryo Transfer. And that is why we thought it is important patients do not waste their money on the wrong thing. They also waste their most productive parts in the hands of these charlatans.

“I was talking to a 50 years old woman who said she went to store her eggs in one clinic, the man does not do IVF, so I don’t know how he can store eggs. 50 years old, she needs donor eggs, she can’t use her own eggs, so what is the clinic storing? And they continue to pay money for this kind of thing. It is so important that people understand some of these things so that they stop doing what can never give them the result they want.

“Regulation is slow, but we are working on it. If you are waiting for legislation, regulation, it is slow, the fastest thing is “buyer beware”. Give them education, once they know where they are buying from, then they are not going to waste their money on some quacks.  How many clinics can you visit a day to police them, what about in a year? If they know you are coming, they will put up their best behaviour, after, they continue with what they are doing. So the easiest thing to do is educate the people who are investing their time and money in these clinics, so they know and can ask their doctors questions. Like this doesn’t look like IVF to me, this sounds like IUI? Imagine a doctor in a Teaching Hospital doing IUI for a 43 year old, that is criminal, you don’t do IUI for a 43 year old. To achieve what?

The problem is that most of the doctors don’t know; you just assume that they know but this is a different branch of medicine. The fact that you are a gynecologist just doesn’t make you a fertility specialist.

“Only someone who has trained in IVF should practice in it because you need to know the indications. If someone can do a surgery and don’t know the indications of the surgery, he will misuse it. So, the fact that someone can do IUI and he don’t know the indications of IUI and he is not humble enough to go and find out the indications, he can have a facility, it doesn’t matter, he is not treating the patients. Like I said, IUI is the most basic form of assisted conception, once someone is trained, he can do it because he don’t need big equipment to do that, all he need is a functioning lab, but the fact that he can do it doesn’t mean the patient needs it. The problem is the doctor must be able to identify the patient who needs it.

“Unfortunately, in this country, not many patients will benefit from IUI because our biggest problems are tubal blockage and sperm quality and these two have contraindication, age. When you spmeone is over 38, it is relative contraindication to IUI because the success rate goes down dramatically not to talk of when someone is 43, she can do one million IUI, that patient is not going to get pregnant even if her tubes are open. It is this half education that is going around the whole place now.

“People who can use IVF are patients whose tubes are blocked, patients who we don’t why they should not have children – they have done the entire test and they are normal, what we call unexplained infertility. Those people if they are less than 38,  they can start with IUI or choose between IUI and IVF. If sperm count is likely not very good, not that it is severely bad, they can try IVF.

When to see an expert

“Couples are advised to come for treatment early. What we define as infertility is when a couple  has tried for one year. For example, if the man knows before he got married that one of his testicles was missing, he knows that there is a problem, such a person should seek help faster.

“If the woman is less than 35, she can wait for one year, if she is over 35,after 6 months, she should be going to do test. If , for example,  the woman also has irregular cycles, then she should wait for one year before seeking help, she should start almost immediately. If she is not ovulating, there are some women who only menstruate four to six times a year, such a patient should see the doctor early so that she can get pregnant but if everything is okay, we say one year before she start investigations, depending on your age. Because everything is age-related. For the woman, she can stay for another one year with your regular gynaecologist if she is less than 32. If there is a problem like the sperm count is bad, tubes are blocked, no need to wait, they should go and start treatment immediately because the earlier they start treatment, the better the success rate. And that is why we say that once someone needs IVF, she should start on time.

“So the message should be that the moment someone has waited for one year, if she is less than 35, she should start assessment. Some people will say they have done their assessment while all they did was scan and they say everything is okay. Scan is not enough for someone to do  assessment. Some people have gone to ten doctors, they have never tested their husband, the semen analysis has not been done. The woman is carrying one arm of a cross.  The tubes must be checked to see whether they are open or not and the way to test tube is doing an x-ray known as HSG or doing a laparoscopy. Doctors must find out whether she is ovulating or not. Then she must do a scan, four basic tests must be done before we can say that the person has done their assessment.

“The figure for normal sperm count is going down, even the World Health Organisation (WHO) is aware of that. Everybody is asking why this should be happening and what was found is that the environment is a major cause. Initially, it was 40 million per male, WHO reduced it to 20 million per male, now it’s 15 million per male that is regarded as normal. So, it’s going down, Over ten years we saw a 30% decline in the sperm parameters of men who presented in this clinic and it’s same all over the world. In Denmark we’ve seen that about 40 percent of their men have low sperm count. So, it’s a big problem all over the world,

“ Fortunately, IVF is taking care of most of the problems with males except if there is none. When there is none,  it poses another problem, someone can go to the testis and try to get but with some people may not get anything. That’s when we use donor sperm. Though they are also trying to develop blood sperm in the laboratory from stem cell but this is still experimental. There are so many technology now in managing sperm abnormalities, we can do PGD, to know the quality of sperm contributed to the embryo . If someone has very poor sperm, the quality of the embryo is going to be bad, either the woman don’t  get pregnant at all by natural selection or she gets pregnant and lose the embryo through miscarriage. So, we can pick an embryo that is healthy. The poorer the quality of sperm, the higher the number of abnormalities in the baby.; We can do DNA testing to see the percentage of sperm cells that have damaged DNA because the only thing a man contributes to fertilisation is his DNA and if that code is damaged, the couple is not going to get anything. Definitely, more men are coming down with infertility,” he said.

 


Weight loss tips that are evidence-based (2)

By Patience Boulor

People are advised to do all sorts of crazy things, most of which have no evidence behind them.Over the years, however, scientists have found a number of strategies that seem to be effective.

Here are some weight loss tips that are actually evidence-based.

Cut back on added sugar

Added sugar is the single worst ingredient in the modern diet, and most people are eating way too much of it.

Studies show that sugar (and high fructose corn syrup) consumption is strongly associated with the risk of obesity, as well as diseases like type 2 diabetes, heart disease and others.

If you want to lose weight, you should be cutting back on added sugars. Just make sure to read labels, because even so-called health foods can be loaded with sugar.

Eat less refined carbs

Refined carbohydrates are usually sugar, or grains that have been stripped of their fibrous, nutritious parts (includes white bread and pasta).

Studies show that refined carbs can spike blood sugar rapidly, leading to hunger, cravings and increased food intake a few hours later. Eating refined carbs is strongly linked to obesity.

If you’re going to eat carbs, make sure to eat them with their natural fiber.

Go on a low carb diet

If you want to get all the benefits of carb restriction, then consider taking this all the way and going on a low carb diet.

Numerous studies show that such a diet (or “way of eating”) can help you lose 2-3 times as much weight as a standard low-fat diet, while improving your health at the same time.

Use smaller plates

Using smaller plates has been shown to help people automatically eat fewer calories in some studies. Weird trick, but it seems to work.

Exercise portion control or count calories

Portion control (eating less) or counting calories can be very useful, for obvious reasons. There are also studies showing that keeping a food diary and writing down what you eat, or taking pictures of all your meals, can help you lose weight .

Anything that increases your awareness of what you are eating is likely to be useful.

Keep healthy food around in case you get hungry

Keeping healthy food close by can help prevent you from eating something unhealthy if you become excessively hungry. A few snacks that are easily portable and simple to prepare include whole fruits, a handful of nuts, baby carrots, yogurt and a hardboiled egg (or two).

 Brush your teeth after dinner

Although I’m not aware of any studies on this, many people recommend brushing your teeth and/or flossing right after dinner. Then you won’t be as tempted to have a late-night snack.

 Eat spicy foods

Spicy foods like Cayenne pepper contain Capsaicin, a compound that can boost metabolism and reduce your appetite slightly.

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